| NPI | 1528491099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: MA PH236935) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH 3896) |
| 183500000X Pharmacist (Licence: ME PR12987) | |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2019-12-17 |